中性粒细胞/淋巴细胞比值是特发性嗜酸性粒细胞增多综合征患者全因死亡率的独立预测指标。

The Neutrophil/Lymphocyte Ratio is an Independent Predictor of All-Cause Mortality in Patients with Idiopathic Hypereosinophilic Syndrome.

作者信息

Xue Junshuai, Jiang Jianjun, Liu Yang

机构信息

Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China.

出版信息

J Inflamm Res. 2022 Mar 15;15:1899-1906. doi: 10.2147/JIR.S357758. eCollection 2022.

DOI:10.2147/JIR.S357758

PMID:35313675

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8934163/

Abstract

BACKGROUND

Idiopathic hypereosinophilic syndrome (IHES) often causes inflammatory damage to multiple organs. However, whether immune/inflammatory indicators and other factors are associated with mortality in patients with IHES remains unclear.

PATIENTS AND METHODS

The clinical data and follow-up results of 167 patients with IHES were retrospectively analyzed using Cox regression analysis and receiver operating characteristic curve (ROC).

RESULTS

Of 167 patients, 120 were men (71.9%) and 47 were women (28.1%). The median age was 52 (36.0, 68.0) years. The median follow-up period was 42.8 (18.5, 75.1) months, during which all-cause mortality occurred in 26 patients (15.6%). Age (HR: 1.041, 95% CI: 1.015-1.068; p = 0.002), lymphocyte counts (10/L, HR: 0.866, 95% CI: 0.816-0.907; p = 0.013), platelet counts (10/L, HR: 0.994, 95% CI: 0.989-0.999; p = 0.012) and NLR (HR: 1.161, 95% CI: 1.054-1.280; p = 0.003) were independent risk factors for all-cause mortality. There was no relationship between PLR, and SII and all-cause mortality (p = 0.181 and 0.202, respectively). ROC analysis showed that the AUCs of age, lymphocyte count (10/L), platelet count (10/L) and NLR were 0.712 (95% CI: 0.601-0.824), 0.584 (95% CI: 0.448-0.719), 0.686 (95% CI: 0.560-0.812), and 0.797 (95% CI: 0.695-0.899), respectively, with sensitivities of 0.5, 0.462, 0.769, and 0.792, respectively, and specificities of 0.765, 0.745, 0.617, and 0.845, respectively. Kaplan-Meier analysis (Log rank test) showed that patients with age ≥73.5 years, lymphocyte count (10/L) <1.45, platelet count (10/L) <225 and NLR ≥2.54 had high mortality. Patients with high NLR (≥2.54) usually have multiorgan involvement, with cardiac involvement and skin involvement being the most common. Patients with NLR ≥2.54 had significantly higher absolute eosinophil counts (p = 0.047) and percentages (p = 0.041).

CONCLUSION

We identified NLR for the first time as an independent predictive factor for all-cause mortality in patients with IHES, necessitating its further application in clinical practice.

摘要

背景

特发性高嗜酸性粒细胞综合征（IHES）常导致多器官炎症性损伤。然而，免疫/炎症指标及其他因素是否与IHES患者的死亡率相关仍不清楚。

患者与方法

采用Cox回归分析和受试者工作特征曲线（ROC）对167例IHES患者的临床资料及随访结果进行回顾性分析。

结果

167例患者中，男性120例（71.9%），女性47例（28.1%）。中位年龄为52（36.0，68.0）岁。中位随访时间为42.8（18.5，75.1）个月，期间26例患者（15.6%）发生全因死亡。年龄（HR：1.041，95%CI：1.015 - 1.068；p = 0.002）、淋巴细胞计数（10⁹/L，HR：0.866，95%CI：0.816 - 0.907；p = 0.013）、血小板计数（10⁹/L，HR：0.994，95%CI：0.989 - 0.999；p = 0.012）和中性粒细胞与淋巴细胞比值（NLR，HR：1.161，95%CI：1.054 - 1.280；p = 0.003）是全因死亡的独立危险因素。血小板与淋巴细胞比值（PLR）和全身炎症反应指数（SII）与全因死亡无相关性（p分别为0.181和0.202）。ROC分析显示，年龄、淋巴细胞计数（10⁹/L）、血小板计数（10⁹/L）和NLR的曲线下面积（AUC）分别为0.712（95%CI：0.601 - 0.824）、0.584（95%CI：0.448 - 0.719）、0.686（95%CI：0.560 - 0.812）和0.797（95%CI：0.695 - 0.899），敏感性分别为0.5、0.462、0.769和0.792，特异性分别为0.765、0.745、0.617和0.845。Kaplan - Meier分析（对数秩检验）显示，年龄≥73.5岁、淋巴细胞计数（10⁹/L）<1.45、血小板计数（10⁹/L）<225且NLR≥2.54的患者死亡率较高。NLR高（≥2.54）的患者通常有多器官受累，以心脏和皮肤受累最为常见。NLR≥2.54的患者绝对嗜酸性粒细胞计数（p = 0.047）和百分比（p = 0.041）显著更高。